Are X-rays for scoliosis harmful?

As mentioned elsewhere my wife suffers from scoliosis. Though her curves are quite severe (45/55) she has tried to avoid surgery and has so far been successful. However, she has had x-rays taken of her spine many times over the years. At least 20 times, perhaps as many as 30 or 40 times in total. We try to limit the number of x-rays as much as we can – but sometimes there is no avoiding it to check up on any potential worsening of the curves.

X-ray devices have improved a lot over the years such that today the amount of radiation emitted is much less than it was 10-20 years ago. However, there is still widespread concern that x-rays may increase chances of developing cancer.

Here is a summary of recent knowledge of x-rays collected by the National Scoliosis Foundation and based on an interview with Dr. Joseph P. Dutkowsky. He explains that a standard x-ray exam where protective measures have been taken to protect the breasts produce very little radiation – around 10 millirads to the breast tissue. Average radiation received from the ground and buildings is around 100 millirads per year, so obviously it is very little. However, with many x-ray exams, little is done to protect the breasts and so the radiation would be higher.

There are some protective measures that everyone can take:

Try to minimize the numbers of x-rays taken in general

Turn your back to the x-ray machine to minimize radiation to the breasts

Stand as far away from the x-ray machine as possible

Ask the hospital whether the x-ray device is of a newer type

Request breast shields, if possible

Request protection for the pelvic region (both boys and girls)

Use a scoliometer, if possible (see below)

Dr. Dutkowsky explains that in 1979, the risk of breast cancer due to x-rays for scoliosis was estimated to be approximately double that of normal folks. However, due to improvements of x-ray devices, by 2016, the risk of breast cancer is estimated to be about the same.

Here is a study from 1989 where 1030 women with scoliosis were tracked over 30 years between 1935 and 1965. The risk of breast cancer seemed to approximately double for these women compared to non-scoliosis patients – though the results are based on quite low numbers.

Here is another study from 2008 where 3010 women with scoliosis were tracked over many years up until 1992. In this study, the risk of breast cancer was closely associated to the severity of curves and the number of x-rays received. Subjects with more than 60 x-rays had a 3-fold risk of developing breast cancer as compared to those with less than 9 x-rays.

So how much has the radiation dose in the average x-ray exam been reduced over the last 30 years? It took me a while to find an answer but finally managed to find a statement here where it indicates that it has dropped to around half since the 1980s.

So it isn’t necessarily correct that the x-ray dose has dropped a lot since the two above research papers were carried out. If it dropped to just the half, then the risk of breast cancer for scoliosis patients is still significantly higher than that of normal women – perhaps 50% higher.

I will continue to track news in this area but the current knowledge still indicates that there is reason to be careful to minimize the number of x-rays taken and to protect your sensitive areas as much as possible during those x-ray exams.

I personally believe that the statement of Dr. Dutkowsky above is too optimistic. Through personal experience we have seen that doctors often believe that x-rays are not harmful and therefore do not care to protect the patient by following any of the above advice. So it is up to you as a patient to demand that some of the above protective measures are taken. My wife had x-rays just a week ago. She was facing towards the x-ray machine (instead of having the back against it) and no breast shields were offered. What is worse is that she recently had other x-rays made by her normal doctor. These x-rays were not of sufficient quality to be used by the back surgeon so new x-rays had to be taken – just one month later.